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  1. Article ; Online: Multi-Reader-Multi-Split Annotation of Emphysema in Computed Tomography.

    Lidén, Mats / Hjelmgren, Ola / Vikgren, Jenny / Thunberg, Per

    Journal of digital imaging

    2020  Volume 33, Issue 5, Page(s) 1185–1193

    Abstract: Emphysema is visible on computed tomography (CT) as low-density lesions representing the destruction of the pulmonary alveoli. To train a machine learning model on the emphysema extent in CT images, labeled image data is needed. The provision of these ... ...

    Abstract Emphysema is visible on computed tomography (CT) as low-density lesions representing the destruction of the pulmonary alveoli. To train a machine learning model on the emphysema extent in CT images, labeled image data is needed. The provision of these labels requires trained readers, who are a limited resource. The purpose of the study was to test the reading time, inter-observer reliability and validity of the multi-reader-multi-split method for acquiring CT image labels from radiologists. The approximately 500 slices of each stack of lung CT images were split into 1-cm chunks, with 17 thin axial slices per chunk. The chunks were randomly distributed to 26 readers, radiologists and radiology residents. Each chunk was given a quick score concerning emphysema type and severity in the left and right lung separately. A cohort of 102 subjects, with varying degrees of visible emphysema in the lung CT images, was selected from the SCAPIS pilot, performed in 2012 in Gothenburg, Sweden. In total, the readers created 9050 labels for 2881 chunks. Image labels were compared with regional annotations already provided at the SCAPIS pilot inclusion. The median reading time per chunk was 15 s. The inter-observer Krippendorff's alpha was 0.40 and 0.53 for emphysema type and score, respectively, and higher in the apical part than in the basal part of the lungs. The multi-split emphysema scores were generally consistent with regional annotations. In conclusion, the multi-reader-multi-split method provided reasonably valid image labels, with an estimation of the inter-observer reliability.
    MeSH term(s) Female ; Humans ; Lung ; Male ; Middle Aged ; Observer Variation ; Pulmonary Emphysema/diagnostic imaging ; Reproducibility of Results ; Tomography, X-Ray Computed
    Language English
    Publishing date 2020-08-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1033897-4
    ISSN 1618-727X ; 0897-1889
    ISSN (online) 1618-727X
    ISSN 0897-1889
    DOI 10.1007/s10278-020-00378-2
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  2. Article ; Online: Evaluation of deep-learning image reconstruction for chest CT examinations at two different dose levels.

    Svalkvist, Angelica / Fagman, Erika / Vikgren, Jenny / Ku, Sara / Diniz, Micael Oliveira / Norrlund, Rauni Rossi / Johnsson, Åse A

    Journal of applied clinical medical physics

    2022  Volume 24, Issue 3, Page(s) e13871

    Abstract: Aims: The aims of the present study were to, for both a full-dose protocol and an ultra-low dose (ULD) protocol, compare the image quality of chest CT examinations reconstructed using TrueFidelity (Standard kernel) with corresponding examinations ... ...

    Abstract Aims: The aims of the present study were to, for both a full-dose protocol and an ultra-low dose (ULD) protocol, compare the image quality of chest CT examinations reconstructed using TrueFidelity (Standard kernel) with corresponding examinations reconstructed using ASIR-V (Lung kernel) and to evaluate if post-processing using an edge-enhancement filter affects the noise level, spatial resolution and subjective image quality of clinical images reconstructed using TrueFidelity.
    Methods: A total of 25 patients were examined with both a full-dose protocol and an ULD protocol using a GE Revolution APEX CT system (GE Healthcare, Milwaukee, USA). Three different reconstructions were included in the study: ASIR-V 40%, DLIR-H, and DLIR-H with additional post-processing using an edge-enhancement filter (DLIR-H + E2). Five observers assessed image quality in two separate visual grading characteristics (VGC) studies. The results from the studies were statistically analyzed using VGC Analyzer. Quantitative evaluations were based on determination of two-dimensional power spectrum (PS), contrast-to-noise ratio (CNR), and spatial resolution in the reconstructed patient images.
    Results: For both protocols, examinations reconstructed using TrueFidelity were statistically rated equal to or significantly higher than examinations reconstructed using ASIR-V 40%, but the ULD protocol benefitted more from TrueFidelity. In general, no differences in observer ratings were found between DLIR-H and DLIR-H + E2. For the three investigated image reconstruction methods, ASIR-V 40% showed highest noise and spatial resolution and DLIR-H the lowest, while the CNR was highest in DLIR-H and lowest in ASIR-V 40%.
    Conclusion: The use of TrueFidelity for image reconstruction resulted in higher ratings on subjective image quality than ASIR-V 40%. The benefit of using TrueFidelity was larger for the ULD protocol than for the full-dose protocol. Post-processing of the TrueFidelity images using an edge-enhancement filter resulted in higher image noise and spatial resolution but did not affect the subjective image quality.
    MeSH term(s) Humans ; Deep Learning ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted/methods ; Tomography, X-Ray Computed/methods ; Image Processing, Computer-Assisted/methods ; Algorithms
    Language English
    Publishing date 2022-12-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2010347-5
    ISSN 1526-9914 ; 1526-9914
    ISSN (online) 1526-9914
    ISSN 1526-9914
    DOI 10.1002/acm2.13871
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  3. Article ; Online: Radiographic airway abnormalities in untreated early rheumatoid arthritis are associated with peripheral neutrophil activation.

    Selldén, Tilia / Mårdh, Carina Kärrman / Joelsson, Martin / Vikgren, Jenny / Johnsson, Åse / Larsson, Gunilla / Glinatsi, Daniel / Stubendorff, Kajsa / Svensson, Karin / Gjertsson, Inger / Rudin, Anna / Lundell, Anna-Carin / Ekwall, Anna-Karin Hultgård

    Arthritis research & therapy

    2023  Volume 25, Issue 1, Page(s) 44

    Abstract: Background: The role of the lung for the initiation and progression of rheumatoid arthritis (RA) is still unclear. Up to 10% of RA patients develop interstitial lung disease which remains a clinical challenge. Understanding early disease mechanisms is ... ...

    Abstract Background: The role of the lung for the initiation and progression of rheumatoid arthritis (RA) is still unclear. Up to 10% of RA patients develop interstitial lung disease which remains a clinical challenge. Understanding early disease mechanisms is of great importance. The objective of this study was to determine whether there is an association between peripheral neutrophil phenotypes and presence of pulmonary abnormalities (PA) on chest high-resolution computed tomography (HRCT) in untreated early RA (ueRA).
    Methods: Clinical data and blood were collected, and HRCT performed at diagnosis on 30 consecutive anti-citrullinated protein antibody (ACPA) and/or rheumatoid factor (RF) positive ueRA patients. HRCTs were evaluated for the presence of RA-associated parenchymal, airway and/or pleural abnormalities. Expression of phenotype markers on neutrophils were determined by flow cytometry. Levels of calprotectin, ACPA and RF were measured using immunoassays.
    Results: The frequency of having any PA was 60%. Airway abnormalities were present in 50%, parenchymal nodules in 43% and interstitial lung abnormalities (ILA) in 10%. Unsupervised multivariate data analysis showed clustering of any PA with neutrophil activation, parameters of inflammation and RF titres. In univariate analysis, the patients with PA displayed significantly increased CD11b and decreased CD62L expression on neutrophils (1.2-fold, p = 0.014; 0.8-fold, p = 0.012) indicating activation and significantly increased RF IgM titre and CRP (5.7-fold, p = 0.0025; 2.3-fold, p = 0.0035) as compared to no PA. Titres of RF, but not ACPA, correlated with expression of the neutrophil activation marker CD11b. A stratified analysis demonstrated that airway involvement was the PA subtype with the strongest association with neutrophil activation.
    Conclusion: We report a strong association between radiographic airway findings and activation of circulating neutrophils in early RA supporting a role of innate immunity and the lung at disease onset. Our results also indicate different contributions of RF and ACPA in the RA pathogenesis.
    MeSH term(s) Humans ; Neutrophil Activation ; Arthritis, Rheumatoid ; Rheumatoid Factor ; Lung/pathology ; Lung Diseases, Interstitial/etiology ; Lung Diseases, Interstitial/complications ; Autoantibodies
    Chemical Substances Rheumatoid Factor (9009-79-4) ; Autoantibodies
    Language English
    Publishing date 2023-03-20
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2107602-9
    ISSN 1478-6362 ; 1478-6354
    ISSN (online) 1478-6362
    ISSN 1478-6354
    DOI 10.1186/s13075-023-03019-5
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    Zs.A 5490: Show issues Location:
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  4. Article ; Online: EVALUATION OF TWO CHEST TOMOSYNTHESIS CYSTIC FIBROSIS SCORING SYSTEMS USING HIGH-RESOLUTION COMPUTED TOMOGRAPHY BRODY SCORING AS REFERENCE.

    Rossi Norrlund, Rauni / Meltzer, Carin / Söderman, Christina / Johnsson, Åse Allansdotter / Vikgren, Jenny / Molnar, David / Gilljam, Marita / Båth, Magnus

    Radiation protection dosimetry

    2021  Volume 195, Issue 3-4, Page(s) 443–453

    Abstract: Purpose: To evaluate two chest tomosynthesis (CTS) scoring systems for cystic fibrosis (CF), one system developed by Vult von Steyern et al. (VvS) and one system based on the Brody scoring system for high-resolution computed tomography (HRCT) (modified ... ...

    Abstract Purpose: To evaluate two chest tomosynthesis (CTS) scoring systems for cystic fibrosis (CF), one system developed by Vult von Steyern et al. (VvS) and one system based on the Brody scoring system for high-resolution computed tomography (HRCT) (modified Brody (mB)). Brody scoring of HRCT was used as reference.
    Methods: In conjunction with routine control HRCT at clinical follow-up, 10 consecutive adult CF patients underwent CTS for research purposes. Four radiologists scored the CTS examinations using the mB and VvS scoring systems. All scores were compared to the Brody HRCT scores. The agreement between the evaluated CTS scoring systems and the reference HRCT scoring system was determined using Spearman's rank correlation coefficient and the intraclass correlation coefficient (ICC).
    Major findings: Spearman's rank correlation coefficient showed strong correlations between HRCT score and both the mB and the VvS CTS total scores (median rs = 0.81 and 0.85, respectively). The ICC showed strong correlation between the CTS scoring systems and the reference: 0.88 for mB and 0.85 for VvS scoring. The median time for scoring was 20 and 10 minutes for the mB and VvS scoring systems, respectively.
    Conclusions: Both evaluated CTS scoring systems correlate well with the reference standard Brody HRCT scoring. The VvS CTS scoring system has a shorter reading time, suggesting its advantage in clinical practice.
    MeSH term(s) Adult ; Cystic Fibrosis/diagnostic imaging ; Humans ; Lung/diagnostic imaging ; Tomography, X-Ray Computed
    Language English
    Publishing date 2021-05-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 225912-6
    ISSN 1742-3406 ; 0144-8420
    ISSN (online) 1742-3406
    ISSN 0144-8420
    DOI 10.1093/rpd/ncab057
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  5. Article ; Online: The Effect of Dose Reduction on Overall Image Quality in Clinical Chest Tomosynthesis.

    Mirzai, Maral / Meltzer, Carin / Vikgren, Jenny / Norrlund, Rauni Rossi / Gottfridsson, Bengt / Johnsson, Åse / Båth, Magnus / Svalkvist, Angelica

    Academic radiology

    2020  Volume 28, Issue 10, Page(s) e289–e296

    Abstract: Rationale and objectives: To evaluate the effect of reduction in effective dose on the reproduction of anatomical structures in chest tomosynthesis (CTS).: Materials and methods: Twenty-four CTS examinations acquired at exposure settings resulting in ...

    Abstract Rationale and objectives: To evaluate the effect of reduction in effective dose on the reproduction of anatomical structures in chest tomosynthesis (CTS).
    Materials and methods: Twenty-four CTS examinations acquired at exposure settings resulting in an effective dose of 0.12 mSv for an average sized patient were included in the study. The examinations underwent simulated dose reduction to dose levels corresponding to 32%, 50%, and 70% of the original dose using a previously described and validated method. The image quality was evaluated by five thoracic radiologists who rated the fulfillment of specified image quality criteria in a visual grading study. The ratings for each image quality criterion in the dose-reduced images were compared to the corresponding ratings for the full-dose examinations using visual grading characteristics (VGC) analysis. The area under the resulting VGC curve (AUC
    Results: The dose reductions resulted in inferior reproduction of structures compared to the original dose level (AUC
    Conclusion: Although previous studies have shown that dose reduction in CTS is possible without affecting the performance of certain clinical tasks, the reproduction of normal anatomical structures is significantly degraded even at small reductions. It is therefore important to consider the clinical purpose of the CTS examinations before deciding on a permanent dose reduction.
    MeSH term(s) Humans ; Radiation Dosage ; Radiation Protection ; Radiography, Thoracic/standards
    Language English
    Publishing date 2020-07-22
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1355509-1
    ISSN 1878-4046 ; 1076-6332
    ISSN (online) 1878-4046
    ISSN 1076-6332
    DOI 10.1016/j.acra.2020.05.041
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  6. Article ; Online: AN ANALYSIS OF THE POTENTIAL ROLE OF CHEST TOMOSYNTHESIS IN OPTIMISING IMAGING RESOURCES IN THORACIC RADIOLOGY.

    Petersson, Cecilia / Båth, Magnus / Vikgren, Jenny / Johnsson, Åse Allansdotter

    Radiation protection dosimetry

    2016  Volume 169, Issue 1-4, Page(s) 165–170

    Abstract: The aim of the study was to investigate the potential role of chest tomosynthesis (CTS) at a tertiary referral centre by exploring to what extent CTS could substitute chest radiography (CXR) and computed tomography (CT). The study comprised 1433 CXR, 523 ...

    Abstract The aim of the study was to investigate the potential role of chest tomosynthesis (CTS) at a tertiary referral centre by exploring to what extent CTS could substitute chest radiography (CXR) and computed tomography (CT). The study comprised 1433 CXR, 523 CT and 216 CTS examinations performed 5 years after the introduction of CTS. For each examination, it was decided if CTS would have been appropriate instead of CXR (CXR cases), if CTS could have replaced the performed CT (CT cases) or if CT would have been performed had CTS not been available (CTS cases). It was judged that (a) CTS had been appropriate in 15 % of the CXR examinations, (b) CTS could have replaced additionally 7 % of the CT examinations and (c) CT would have been carried out in 63 % of the performed CTS examinations, had CTS not been available. In conclusion, the potential role for CTS to substitute other modalities during office hours at a tertiary referral centre may be in the order of 20 and 25 % of performed CXR and chest CT, respectively.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography, Thoracic/methods ; Referral and Consultation ; Reproducibility of Results ; Tertiary Care Centers ; Thorax/diagnostic imaging ; Tomography, X-Ray Computed/methods ; Young Adult
    Language English
    Publishing date 2016-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 225912-6
    ISSN 1742-3406 ; 0144-8420
    ISSN (online) 1742-3406
    ISSN 0144-8420
    DOI 10.1093/rpd/ncw040
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  7. Article ; Online: The association between cadmium exposure and chronic airflow limitation and emphysema: the Swedish CArdioPulmonary BioImage Study (SCAPIS pilot).

    Torén, Kjell / Olin, Anna-Carin / Johnsson, Åse / Vikgren, Jenny / Forsgard, Niklas / Bergström, Göran / Sallsten, Gerd / Barregård, Lars

    The European respiratory journal

    2019  Volume 54, Issue 5

    MeSH term(s) Cadmium/adverse effects ; Female ; Humans ; Lung/drug effects ; Lung/physiopathology ; Male ; Middle Aged ; Occupational Diseases/chemically induced ; Occupational Diseases/epidemiology ; Occupational Diseases/physiopathology ; Occupational Exposure ; Pilot Projects ; Prevalence ; Pulmonary Emphysema/chemically induced ; Pulmonary Emphysema/epidemiology ; Pulmonary Ventilation/drug effects ; Sweden
    Chemical Substances Cadmium (00BH33GNGH)
    Language English
    Publishing date 2019-11-21
    Publishing country England
    Document type Letter ; Research Support, Non-U.S. Gov't
    ZDB-ID 639359-7
    ISSN 1399-3003 ; 0903-1936
    ISSN (online) 1399-3003
    ISSN 0903-1936
    DOI 10.1183/13993003.00960-2019
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  8. Article ; Online: Chest tomosynthesis: technical and clinical perspectives.

    Johnsson, Ase Allansdotter / Vikgren, Jenny / Bath, Magnus

    Seminars in respiratory and critical care medicine

    2014  Volume 35, Issue 1, Page(s) 17–26

    Abstract: The recent implementation of chest tomosynthesis is built on the availability of large, dose-efficient, high-resolution flat panel detectors, which enable the acquisition of the necessary number of projection radiographs to allow reconstruction of ... ...

    Abstract The recent implementation of chest tomosynthesis is built on the availability of large, dose-efficient, high-resolution flat panel detectors, which enable the acquisition of the necessary number of projection radiographs to allow reconstruction of section images of the chest within one breath hold. A chest tomosynthesis examination obtains the increased diagnostic information provided by volumetric imaging at a radiation dose comparable to that of conventional chest radiography. There is evidence that the sensitivity of chest tomosynthesis may be at least three times higher than for conventional chest radiography for detection of pulmonary nodules. The sensitivity increases with increasing nodule size and attenuation and decreases for nodules with subpleural location. Differentiation between pleural and subpleural lesions is a known pitfall due to the limited depth resolution in chest tomosynthesis. Studies on different types of pathology report increased detectability in favor of chest tomosynthesis in comparison to chest radiography. The technique provides improved diagnostic accuracy and confidence in the diagnosis of suspected pulmonary lesions on chest radiography and facilitates the exclusion of pulmonary lesions in a majority of patients, avoiding the need for computed tomography (CT). However, motion artifacts can be a cumbersome limitation and breathing during the tomosynthesis image acquisition may result in severe artifacts significantly affecting the detectability of pathology. In summary, chest tomosynthesis has been shown to be superior to chest conventional radiography for many tasks and to be able to replace CT in selected cases. In our experience chest tomosynthesis is an efficient problem solver in daily clinical work.
    MeSH term(s) Artifacts ; Humans ; Radiation Dosage ; Radiographic Image Enhancement/methods ; Radiography, Thoracic/methods ; Sensitivity and Specificity ; Solitary Pulmonary Nodule/diagnostic imaging ; Solitary Pulmonary Nodule/pathology ; Tomography/methods ; Tomography, X-Ray Computed/methods
    Language English
    Publishing date 2014-02
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 1183617-9
    ISSN 1098-9048 ; 1069-3424
    ISSN (online) 1098-9048
    ISSN 1069-3424
    DOI 10.1055/s-0033-1363448
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  9. Article ; Online: A retrospective study of chest tomosynthesis as a tool for optimizing the use of computed tomography resources and reducing patient radiation exposure.

    Johnsson, Åse A / Vikgren, Jenny / Båth, Magnus

    Academic radiology

    2014  Volume 21, Issue 11, Page(s) 1427–1433

    Abstract: Rationale and objectives: To investigate potential benefits and drawbacks of the clinical use of chest tomosynthesis (CTS), to what extent CTS obviates the need for chest computed tomography (CT), and what reduction in radiation dose thereby can be ... ...

    Abstract Rationale and objectives: To investigate potential benefits and drawbacks of the clinical use of chest tomosynthesis (CTS), to what extent CTS obviates the need for chest computed tomography (CT), and what reduction in radiation dose thereby can be achieved.
    Materials and methods: The Regional Ethical Review Board approved the follow-up study of patients examined with CTS as part of clinical routine. For each case, two radiologists in consensus determined whether CT would have been performed, had CTS not been an option, and whether CTS was an adequate examination. Thereafter, it was determined whether the use of CTS instead of CT in retrospect was beneficial, neutral, or detrimental for the radiological work-up. The radiation dose to the patient population was determined both for the actual clinical situation and for the alternative scenario that would result, had CTS not been available.
    Results: During 1 month 3.5 years before the survey, 149 patients (74 women, age 18-91 years) had undergone CTS for clinical purposes. It was judged that CT would have been performed in 100 cases, had CTS not been available, and that CTS obviated the need for CT in 80 cases. CTS was judged as beneficial, neutral, and detrimental for the radiological work-up in 85, 13, and two cases, respectively. For the entire study population, the use of CTS decreased the average effective dose from 2.7 to 0.7 mSv.
    Conclusions: The present study indicates that CTS may have benefits for the radiological work-up as it has the potential to both optimize the use of CT resources and reduce the effective dose to the patient population. A drawback is that CTS examinations may fail to reveal pathology visible with CT and in clinically doubtful cases further investigations including other imaging procedures should be considered.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Female ; Humans ; Lung Neoplasms/diagnostic imaging ; Male ; Middle Aged ; Radiation Dosage ; Radiation Protection/methods ; Radiation Protection/statistics & numerical data ; Radiographic Image Enhancement/methods ; Radiographic Image Interpretation, Computer-Assisted/methods ; Radiographic Image Interpretation, Computer-Assisted/utilization ; Radiography, Thoracic/methods ; Radiography, Thoracic/utilization ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Solitary Pulmonary Nodule/diagnostic imaging ; Tomography, X-Ray Computed/methods ; Tomography, X-Ray Computed/utilization ; Young Adult
    Language English
    Publishing date 2014-11
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1355509-1
    ISSN 1878-4046 ; 1076-6332
    ISSN (online) 1878-4046
    ISSN 1076-6332
    DOI 10.1016/j.acra.2014.06.002
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  10. Article ; Online: Occupational exposure to vapor, gas, dust, or fumes and chronic airflow limitation, COPD, and emphysema: the Swedish CArdioPulmonary BioImage Study (SCAPIS pilot).

    Torén, Kjell / Vikgren, Jenny / Olin, Anna-Carin / Rosengren, Annika / Bergström, Göran / Brandberg, John

    International journal of chronic obstructive pulmonary disease

    2017  Volume 12, Page(s) 3407–3413

    Abstract: Background: The aim of this study was to estimate the occupational burden of airflow limitation, chronic airflow limitation, COPD, and emphysema.: Materials and methods: Subjects aged 50-64 years (n=1,050) were investigated with forced expiratory ... ...

    Abstract Background: The aim of this study was to estimate the occupational burden of airflow limitation, chronic airflow limitation, COPD, and emphysema.
    Materials and methods: Subjects aged 50-64 years (n=1,050) were investigated with forced expiratory volume in 1 s (FEV
    Results: There were significant associations between occupational exposure to VGDF and COPD (OR 2.7, 95% CI 1.4-51), airflow limitation (OR 1.8, 95% CI 1.3-2.5), and emphysema (OR 1.8, 95% CI 1.1-3.1). The associations between occupational exposure to VGDF and chronic airflow limitation were weaker, and for the OR, the CIs included unity. The population-attributable fraction for occupational exposure to VGDF was 0.37 (95% CI 0.23-0.47) for COPD and 0.23 (95% CI 0.05-0.35) for emphysema.
    Conclusion: The occupational burden of COPD and computed tomography-verified emphysema is substantial.
    MeSH term(s) Air Pollutants, Occupational/adverse effects ; Chi-Square Distribution ; Cross-Sectional Studies ; Dust ; Environmental Monitoring ; Female ; Forced Expiratory Volume ; Gases/adverse effects ; Humans ; Logistic Models ; Lung/diagnostic imaging ; Lung/drug effects ; Lung/physiopathology ; Male ; Middle Aged ; Occupational Diseases/chemically induced ; Occupational Diseases/diagnosis ; Occupational Diseases/epidemiology ; Occupational Diseases/physiopathology ; Occupational Exposure/adverse effects ; Occupational Health ; Odds Ratio ; Pilot Projects ; Prevalence ; Pulmonary Disease, Chronic Obstructive/chemically induced ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Pulmonary Disease, Chronic Obstructive/physiopathology ; Pulmonary Emphysema/chemically induced ; Pulmonary Emphysema/diagnosis ; Pulmonary Emphysema/epidemiology ; Pulmonary Emphysema/physiopathology ; Risk Assessment ; Risk Factors ; Spirometry ; Surveys and Questionnaires ; Sweden/epidemiology ; Tomography, X-Ray Computed ; Vital Capacity ; Volatilization
    Chemical Substances Air Pollutants, Occupational ; Dust ; Gases
    Language English
    Publishing date 2017-11-29
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2212419-6
    ISSN 1178-2005 ; 1176-9106
    ISSN (online) 1178-2005
    ISSN 1176-9106
    DOI 10.2147/COPD.S144933
    Database MEDical Literature Analysis and Retrieval System OnLINE

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